Project Summary Cardiovascular disease (CVD) is the United States' leading cause of morbidity, mortality, and health care costs, but proven CVD risk reduction strategies are often not fully used. Medications such as HMGCoA reductase inhibitors, commonly referred to as ?statins,? can reduce CVD risks. However, up to 34% of patients never fill a newly prescribed statin (primary nonadherence), and consequently fail to reduce their CVD risk. Data about primary nonadherence are sparse. The limited data counterintuitively suggest higher rates of primary statin nonadherence in some populations at greater risk for CVD, such as blacks and Hispanics/ Latinos, but the reasons for these disparities are unknown. There is incomplete information about the interplay of patient, healthcare system and provider factors underlying primary nonadherence, and about the type and content of motivational strategies that might encourage primary statin adherence. It is crucial to accurately identify reasons for primary statin nonadherence order to ultimately help people lower their CVD risk. The long-term goal of this research agenda is to reduce CV risk by developing patient-targeted tailored interventions to promote medication adherence. This study will contribute a comprehensive understanding of the reasons that patients choose not to fill a newly prescribed statin, and patient preferences for solutions to overcome primary nonadherence. This cross-sectional study has two phases. In Phase 1, focus group and semi-structured interviews with middle-aged and older white, black, and English- and Spanish-speaking Hispanic/Latino patients will yield open-ended data exploring the range of reasons patients decide not to fill initial statin prescriptions (focusing on patient attitudes and beliefs), and solicit ideas for potential solutions to overcome these barriers. In Phase 2, we will develop and pilot-test a structured survey with a separate patient cohort (Aim 2). Cognitive interviews will be used to refine survey content and wording. Eligible study patients will be identified by querying standardized databases from a PCORnet (PCORI's National Clinical Research Network) Patient-Powered Research Network (Health eHeart) (Phase 1) and from a PCORnet Clinical Data Research Network (pScanner) and the University of California healthcare system (UC ReX) for Phases 1 and 2. The study's specific aims are to: 1) determine: a) patient attitudes, beliefs, and other factors associated with primary statin nonadherence and b) patient suggestions to overcome these barriers; and 2) develop and pilot-test English- and Spanish-language surveys to understand patient characteristics (e.g., demographics, health) related to: a) patient-reported reasons for primary statin nonadherence and b) preferred strategies to overcome primary statin nonadherence. We expect this study to provide critical preliminary information for the design and conduct of a future larger-scale survey, which will in turn inform the content of tailored patient-targeted interventions to reduce primary statin nonadherence, and ultimately reduce CVD risks.